ldcmw1

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Our policy is wait one hour but I have never seen it done. We usually try something different after that. ldcmw

Sorry for no paragraphs! I just kept typing away in frustration! Will do better next time. I will be writing up a QI on this and I will be taking this up with the Chief OB. Mom delivered about a hour after I went home. Baby went to regular nursery and as far as I know all went well. I'm glad but there is so much information out there on late pre-term infants these days, why would you take the risk of delivering someone early for no good reason. Thanks for all your support!!!!

Mrs. Ortiz - Where is the pain? Is she bleeding. Obviously she is not going to get up to ambulate yet. The dry mouth has me stumped but I thought I remember it could possibly be a side effect of having a morphine PCA. O2 Sat is still 96% and there is no previous report of what it was before or respiratory rate was before that so how do you know her condition is worsening without that information. The resident should come and see her. Ms. Douglas - I would report to the resident her cramping and when you got off the phone with him put her on the external fetal monitor. As far as the gush of clear fluid that isn't so alarming. It isn't blood tinged or green and is normal if she is ruptured and cramping.

Thanks guys for all the positive feedback!!! I'm just so frustrated!

I worked a 12 hour shift yesterday and did c/s's until 3 pm when I picked up a patient from another nurse I was upset after getting report. The patient was a frequent flyer. 26 yrs old g5 p4 at 35 6/7 weeks admitted many times for low back pain and pre-term ctxs. Received betamethasone 3 weeks previously. Her chief complaint when arriving on the unit at around 5 am was contractions. She was so uncomfortable the nurse checked her right away and charted she was 2/70/-2. Called the MD and he told her to treat her for a UTI and to start ampicillin 2 grams. He didn't ask for a UA to be sent even after the nurse requested it. She started the IV gave ampicillin and handed her off to the day shift nurse. MD saw pt around 8 am and checked her cervical exam 2/70/-2. Patient was contracting upon admission and was still contracting when MD saw her but no cervical change. He ordered Nubain 10 iv and 10 im. Patient was ok for about an hour but then was uncomfortable again and MD told nurse to give pt an epidural she was in labor. Patient got an epidural and was nice and comfortable she was still contracting every 3-5 minutes when nurse checked the patient around noon. Patients cervix hadn't changed. MD ordered pitocin to be started. The nurse caring for the patient questioned it but the MD was adamant. When I received the patient at 3 pm she was on 22 mu of pitocin. The patient had just been checked at 2:45 pm by the MD and she was 2/70/-1. The patient had made no cervical change for 10 hours clearly she wasn't in labor and we are essentially inducing someone who is not even 36 weeks. I explained to my charge nurse I was going up the chain of command. I spoke to my assistant manager and manager and explained the case to them. I didn't feel supported by them and they told me to speak to the physician and ask him for the rationale of why he was doing this. I called the physician and he explained that the patient was in labor. I stated that from all the information I gathered the patient hadn't changed her cervix for 10 hours. That isn't labor even if you are contracting! He told me the patient had made cervical change and I asked him when? He said her last exam I just didn't make a note of it when I checked her. I stated it was charted by the nurse and the only thing that had changed in 10 hours is that the head went from -2 to -1 (very subjective). He then stated he didn't have to explain to me why this patient was on pitocin and being admitted for labor and hung up on me. He then called the charge nurse and told her he didn't want me taking care of the patient! I then went in and spoke to both my manager and assistant manager and told them what transpired. They told me they would support me if I called the chief OB and I was happy with that but felt like he wouldn't support my decision and would say "What do you want me to do?" The chief OB still does fundal pressure on his patients when he does deliveries so how do you think I'm gonna get anywhere with him! I handed the patient off to another nurse and finished my shift. I didn't feel right taking care of her knowing what was being done to her was wrong! The sad part is that she wanted to deliver her baby. She was sick of being pregnant!!! I'm just so over this mentality!!! I was only trying to do the right thing and protect this innocent unborn child!!! I feel like being a patient advocate gets me nowhere except being a difficult nurse to work with!!! I'm just so sick of it!! I'm frustrated and want to quit!!!!:angryfire

Smith sounds like she should be a one on one!!! She is sick, sick, sick!!!! Teen 1st pregnancy!!! High Risk for pre-clampsia and with blood pressure's that high she could stroke out!! Nothing is said about her lab results on admission? I have rarely ever had a patient with blood pressures that high and I've been a labor and delivery nurse for 12 yrs. She would be on Magnesium Sulfate where I work!!! This assignment is ridiculous!!! Anyway I know this is hypothetical but she would be #1 to see. Check her BP, Neurological status, edema, reflexes, does she have epigastric pain, fetal status, urinary output. Has she been started on steroids for fetal lung maturity? #2 Ortiz, 2 hours post-op, check bleeding (at dressing site and lady partslly), o2 sat, lung sounds, pain assessment, urinary output, vital signs. Check PCA with another RN against orders! Does she have pneumatic teds on. #3 Linden what has her temp been? What antibiotics has she been on? Is she in pain has it recently gotten worse. When was the last time she received an antipyretic? Lab results? Is she getting plenty of fluids? #4 PPROM, she seems pretty stable. Take vital signs, has she felt baby move, is she having pain or contractions? How much fluid is she leaking? I would want to know about her latest ultrasound(how much fluid does she have, position of baby). Have her call you if she feels pain, ctx, decreased fetal movement, bleeding, anything coming out of the lady parts.

Interesting case!!! I'm curious to know what became of mom and baby and sounds like the baby had an arrythmia. I just had this happen to me a few weeks ago. We knew the baby had an arrythmia and she came up to our unit from the perinatal center to be induced. Baby looked fine for about 30 minutes then converted to arrythmia and fhr was in 70's. I told OB there was no way we could induce her. He did C/S baby came out fine and converted at birth.

My question to you would be why is she on continious monitoring? Evidence based research doesn't seem to support this? I do feel sorry for her and she needs to be treated with respect and not be shuffled all over the place! At my facility once they get their second dose of steroids they are weaned off the Magnesium Sulfate given indocin for 48 hours and put on procardia.

Where I work to use Labetalol IV they have to be hooked up to a cardiac monitor. Not the case with hydralazine. Yes, the hypertension is a symptom of the problem but it still needs to be treated! Do you want your patient to stroke out. I'm guessing as an EMT your patient does have an IV. I prefer hydralazine myself. It increases uterine perfusion. Be careful to use labetalol on a patient with asthma it is contraindicated. Lastly, you don't want to drop the blood pressure too much or the fetus won't like that.

I was taught the same way Pitocin on the closest port. You should always always have all your fluids on a pump when running Mag Sulfate. Especially if they are on Mag for PIH! I've never worked anywhere that it hasn't been the case.

Thank!!!!

Help!! I'm orienting a nurse to our labor and delivery unit who has about 6 months of experience in this area. I'm having many problems with her. She is slow, doesn't prioritize properly and seems to lack intiative. I'm constantly reminding her to do things that I've told her to do many times before, questioning her on why she is doing this before that, taking an hour to do an admission assessment, and the list goes on. I'm beginning to think she might not be cut out for our labor and delivery unit. Our unit is very fast paced and can even overwhelm very experienced nurses at times. On the plus side she is awesome with the patients and on a personal level I like her. I'm at a loss as what to do. Any words of wisdom from those of you who have been there before would be greatly appreciated.

here is a website on the cook catheter. cervical ripening balloon the cook cervical ripening balloon offers a safe, simple method for cervical ... i. ripening of the unfavorable cervix with extraamniotic catheter balloon: ... www.cookmedical.com/wh/features/crb_en.../index_crb.html

I just can't believe they insert the cytotec in the office!!! How much of a time lapse from the time they place the cytotec to when they come to the hospital to be admitted? What dosage are they using. That seems a little scary to me. Not for nursing but the MD's doing that.

Thanks, we are trying to change our policy at our hospital. The circulating nurse catches baby and then is responsible for doing all the computer charting, counts, running to get things if needed, calling for cord ph, collecting cord blood, etc. Many times when we have sterile gloves and blanket and are ready to pass baby to NICU team MD will ask for kiwi or delee and we have to drop blanket and take off gloves and grab what they need. We usually don't have time to put new gloves on before delivery and grab baby with no gloves and sterile blanket that is no longer sterile. Neo and NICU nurse come to room for all our C/S's and basically stand and wait for baby to be born. Now common sense would tell you that two of them are waiting to receive baby why not have one of them catch baby and bring to infant warmer. The argument is that they don't know about sterile technique.... hum they work in the NICU performing plenty of procedures that require sterile technique. Just can't figure out the resistance to change things. Sometimes we have an extra nurse back there to help us but USUALLY we are too busy and are back there alone in the OR. As far as counting we do full count before surgery, we use to do just laps and sutures at uterus but now do four full counts: before, at uterus closure, peritoneum, and skin. I just wanted to know what the procedure was at other hospitals. Also, do you give antibiotics before surgery or at cord clamping?

So the OB brings baby over to the warmer? What about leaving the sterile field and yes I know the surgeon is doing surgery and must be gowned and gloved? Do you also do a full count at closure of the peritoneum? NICU doesn't come to every C/S? How many nurses do you have in OR if NICU doesn't come to delivery? In my opinion, it doesn't seem right to have the circulating nurse do all of that by herself.

Does anybody use the cook catheter for cervical ripening? If so please tell me your results and thoughts on it? We just got it at our hospital and I'm curious as to how effective it is. I like the fact that your not giving any medication to the mom and it can be taken out fairly easy. Thanks!!

Is there anybody out there that works at a facility that uses the Stan Fetal Monitor? I would love to hear about it! Curious to know if it cuts down on assisted delivries and c/s?

I'm curious as to who catches your baby during a c/s and do they wear a sterile gown and gloves? Does the NICU nurse do a set of vital signs on the baby? Do you do a full count at uterine closure?

We use 25 mcg lady partslly every 4 hours. Patient has to be continually monitored. Pitocin can't be started until 4 hours after the last dose. Patient doesn't have to have IV access but some docs and midwives will order it. We have to chart on fhr and uterine activity every 15 minutes. I hope this helps. If an IUFD we give 400 mcg per lady parts or rectum every 6 hours. A couple of weeks ago I had a patient who was given 25 mcg of cytotec and her baby got very tachy about 2 hours later. Mom had no fever and the tachycardia didn't go away with a fluid bolus. I have never seen that before.

Hello, I anybody using fentanyl for pain relief in labor? If so, how much is used. How often and does it work well? What effects do you see on the baby? Thanks, ldcmw

I appreciate your feedback. The problem is that she has no idea how to run our unit!!! There are numerous times we bring to her attention that we are practicing out of AWHONN guidelines and ask for her help and we get none!!! She continually patronizes us and when we explain that we need to cancel procedures because the unit is too busy she doesn't support us. These are only a few of the issues we have with her. I disagree with your comment about a manager being successful without ever having been a labor and delivery nurse. That is just my opinion. I want to know that I can call on my manager and she will come and help out on the unit when we need it. The best managers I've ever had regardless of the job have been the ones that helped out wherever and whenever needed. I've had managers stripping beds for us, transferring pts, answering call bells, acting as secretary, taking care of patients if we need her to, and etc.

I work in one of the largest metropolitan areas in the country and a fairly busy labor and delivery unit. We do around 350 deliveries a month. I've worked on our unit for 12 yrs and in the 12 yrs I've worked here we have never had a nurse manager who hasn't had atleast a Bachelor's degree in nursing. Our new nurse manager only has an associates degree in nursing and came to our hospital as a travel nurse initially and hasn't been a labor and delivery nurse for very long. I'm just curious as to what qualifications other l&d nurse managers have around the country.

Wow, I feel so much better after reading this post! Same thing happens at my hospital. The charge nurse is always in the uncomfortable position of telling the patient that they have to leave and either come back later that day or the next day. Then we get flack from the ob's and patient. We aren't backed up by our manager either! She will try and push things to the limit and would rather have the unit unsafe then upset the doc's or patient.